Bonding vs Gum Grafting

Composite bonding and gum grafting are two superb ways to cover exposed tooth roots and treat gum recession, but they address the problem in different ways. One is an affordable and less invasive treatment while the other may offer a more long-term solution in some patient groups. Let’s take a closer look at these two treatment options to help you decide which is best for you. 

What Is Composite Bonding vs Gum Grafting?

Here’s a quick explanation of the two methods.

Gum Grafting

A variety of gum grafting procedures are available to treat gum recession. They have all been shown statistically to cover root exposure. 

• Free tissue graft – soft tissue is harvested from the palate from the area of gum recession and grafted over the exposed root. The tissue is sutured into place. You have two surgical sites with this procedure.  There are two types of procedures one uses connective tissue and the other uses epithelial tissue. 
• Pedicle grafts –  donor tissue from an area adjacent to the recession defect is used to cover the exposed root surface. The tissue is sutured into place. 
• Pinhole Surgery ®  – this is a specialized technique similar to a pedicle graft. A pinhole incision is made below the area of recession and healthy tissue is stretched to cover the exposed root. The tissue is secured in place with collagen strips. 
• Guided Tissue Regeneration – A flap is created around the area of recession, and a membrane is used to cover the exposed root and covered with the flap of gum tissue. 
• Allograft  & Xenograft – exposed root is covered with tissue from a cadaver or another animal

Pros

• Improves root sensitivity and esthetics.
• Careful patient selection and technique can yield successful results
• May last a lifetime when looked after 

Cons

• Expensive
• Invasive and painful
• Not all patients are suitable candidates
• A second procedure may be required to achieve full coverage of the tooth root 
• Lengthy recovery time

Composite Bonding

Composite bonding is a popular and predictable treatment in the management of gum recession. 

The non-invasive procedure involves placing tooth-coloured composite resin (similar to the polymer used to repair cavities in the back teeth instead of amalgam fillings) over the exposed tooth root. When there are aesthetic concerns gum coloured resins can be used successfully by skilled aesthetic dentists to make the gumline filling appear more natural.

Composite bonding can be used to cover exposed root surfaces when there is a small localised recession and on some occasions extensive recession where there has been bone loss following periodontal disease (gum disease).  It can also be used to close black triangles that appear as a result of extensive bone loss and gum recession. 

Pros

• Non-invasive
• Affordable
• Completed in just one visit to the dental office
• No drilling or injections

Cons

• May need to be replaced in 5-10 years
• If placed incorrectly it could result in plaque retention, gum disease and further gum recession

Composite Bonding vs Gum Grafting:

Procedure

Composite bonding wins hands down here as it can usually be completed within a single visit to the dental office. The procedure is non-invasive, there is no need for the dentist to make any incisions, drill or offer any injections. You can walk out of the surgery with a new smile within the day. 

All gum grafting procedures are invasive and painful. All methods involve making incisions into the gum. Whilst no drilling is involved, anaesthetic is required and some patients opt for sedation. Some methods require two surgical sites – one in the area of gum recession and one either in the palette or an area of healthy gum. 

Recovery Time

Another win for composite bonding here. There is no recovery time required. 

However, following a gum grafting procedure, you may need to take time off work and take it easy for 48 hours. There may be excessive bleeding and you may need to eat a restricted diet of soft foods for several days or weeks.

Price

In general composite bonding is more affordable than gum grafting which can cost in the region of $800-$2000 for treatment in one-quarter of the mouth.  The exact cost will depend on your individual needs. So, the best way to find out is to have a consultation with your dentists who will give you more accurate costs based on your unique smile. 

Appearance

Whilst gum and tooth-coloured composite bonding can be applied by skilled aesthetic dentists to look natural if someone looks closely they may be able to see the gumline fillings depending on how well they are placed. Gum grafting once healed will look natural and seamless – if the procedure has been carried out by a skilled periodontist.

Eligibility

Ultimately, your dentist will determine your suitability for either treatment, however, you may be a good candidate if you meet the following criteria:

Composite bonding:

• You have small localised areas of recession
• Plenty of intact tooth and root for your dentist to apply the resin to
• You need to be in good oral health

Gum Grafting

• Good oral health
• No gum disease

Durability

The grafted gum tissue will be as durable as natural gums once fully healed. Composite bonding can be chipped and scratched, however, it is easily repaired or replaced. 

If the cause of your gum recession is not addressed, any grafted tissue could recede in the same way. 

Maintenance

As we have already indicated composite binding will need replacing in 5-10 years. 

In general composite bonding and gum grafts will require the same maintenance

• Use a Gum Pocket Brush daily to remove harmful periodonitits-causing plaque.
• Avoid food and drink which will stain your teeth or composite resin
• Avoid smoking which can result in gum disease and gum recession
• Tooth grinding is known to exacerbate gum recession – if you suspect you grind your teeth when asleep or awake speak to your dentist about a mouth guard. 
• Remove oral piercings
• Develop and maintain oral hygiene which is first class. Brush the teeth twice a day and floss daily using the correct technique.

Which is Best? Bonding or a Gum Graft?

Whilst your expert dentist is the best person to advise you comprehensively on which option is most suitable to your unique smile, gum recession and oral health we can give you an indication of which may be suitable.

In general, 

• Gum grafting can be a more permanent, long-lasting, more aesthetic solution when the correct procedure is selected for the ideal candidate. 
• Composite bonding will cover the exposed tooth roots, eliminating sensitivity, and is affordable and available to most people. 

Opt for composite binding if you have:

• Small localised recession with sensitivity, wear or root surface decay
• Gum grafting surgery is not a viable option 
• You do not want to pursue gum grafting for financial or other reasons.

Use gum grafting if:

• You have large areas of gum recession and gum-coloured composite will not be aesthetically acceptable
• You are a suitable candidate for gum grafting vs composite bonding

Sources for Bonding vs Gum Grafting

1. Patel, M., Nixon, P. & Chan, MY. Gingival recession: part 1. Aetiology and non-surgical management. Br Dent J 211, 251–254 (2011). Available here: https://doi.org/10.1038/sj.bdj.2011.764
2. Patel M, Nixon PJ, Chan MF. Gingival recession: part 2. Surgical management using pedicle grafts. Br Dent J. 2011 Oct 7;211(7):315-9. doi: 10.1038/sj.bdj.2011.821. PMID: 21979345. Available here: https://pubmed.ncbi.nlm.nih.gov/21979345/
3. Patel M, Nixon PJ, Chan MF. Gingival recession: part 3. Surgical management using free grafts and guided tissue regeneration. Br Dent J. 2011 Oct 21;211(8):353-8. doi: 10.1038/sj.bdj.2011.861. PMID: 22015511. Available here: https://pubmed.ncbi.nlm.nih.gov/22015511/